The most recent mass shooting has led to a rare opportunity to effect change

In the aftermath of the tragic mass shooting in Newtown, Connecticut, on 14 December—where 20 young children and seven adults, including the perpetrator, were killed—there seems to be a newfound willingness among policy makers and the public to consider common sense gun policy reforms. This is a debate that until now has been conspicuously absent in the United States.

Although mass shootings have increased in recent years, the resultant deaths are just the tip of the iceberg. Guns are used to kill about about 86 people in the US each day,1 and the US has long been an outlier among high income countries in its firearm death rate. This difference is most starkly illustrated by the homicide rate in the US, which is seven times higher than that of 22 other high income nations. The high rate of homicides in the US is driven by a firearm homicide rate that is 20 times higher than in other countries.2

Contrary to pro-gun lobby claims, research into prevention of gun violence has shown that reasonable reforms could reduce the excessively high rates of firearm deaths in the US while preserving access to guns among law abiding citizens.3 These include laws that would keep guns from high risk people by requiring background checks on all firearm transactions and expanding the categories of those who are proscribed from legally possessing firearms.

Federal law currently requires anyone who purchases a gun from a federally licensed firearms dealer to present government issued identification and pass a background check. Yet, an estimated 40% of all firearm acquisitions,4 and nearly 80% of handgun acquisitions among state prison inmates who used a handgun to commit a crime,5 come from private sources. In all but a handful of states, it is perfectly legal for criminals, gun traffickers, and others to skirt the background check requirement by obtaining firearms from unlicensed sellers.

Rates of firearm trafficking are significantly lower in US states where a background check is legally required for all firearm transactions.6 This suggests that closing the private sales loophole that allows the acquisition of firearms from private sellers without a background check would prevent the diversion of guns to criminals and underage youth, and that any efforts to prevent gun deaths should make this a high priority.

Although federal law makes it illegal for felons and those convicted of domestic violence to possess firearms, possession is not illegal for people convicted of other violent crimes under federal law and the laws of most states. By focusing on disallowing gun possession for convicted felons, people at increased risk for committing violence are overlooked. A study of adult homicide offenders in Illinois found that most had a criminal history, but only 43% had a felony conviction that would have disqualified them from possessing firearms under federal law.7 Moreover, according to analysis of data from a survey of state prison inmates in the 13 US states with the least stringent gun laws who used a gun in the crime for which they were incarcerated, only 27% had been prohibited from possessing firearms owing to a previous felony conviction.8 Firearm prohibitions should be extended to include anyone convicted of any violent crime and adults who were convicted of serious crimes as juveniles.

A considerable body of research shows that those who misuse alcohol and illicit substances are at increased risk for perpetrating violence.9 Federal law prohibits the possession of firearms by those addicted to illegal drugs, but the law’s narrow definition of illegal drug addiction omits many people who are at high risk of violence. People who misuse alcohol are not covered by federal law and are prohibited from firearm possession in just 16 US states. Current restrictions on firearm possession should be expanded to include those who misuse alcohol as well as illegal drugs.

People under the age of 21 years should also be prohibited from possessing firearms. Current federal law prohibits the possession of a handgun by anyone under 18 years but does not set age restrictions on the possession of long guns. Only five US states set minimum age requirements for firearm possession above that of federal law. The risk for being a perpetrator or victim of violence is highest among adolescents and young adults. Age specific homicide rates rise markedly during late adolescence and peak at age 20,10 the age of the gunman in the Connecticut shooting. The heightened risk taking behavior that is characteristic of adolescence may result from the fact that the areas of the brain responsible for impulse control continue developing into young adulthood.11

This recent mass shooting has led to a rare opportunity for proponents of stricter gun regulations to effect change. The reforms that are proposed do not infringe on law abiding citizens’ access to firearms and are supported by most gun owners. The US Supreme Court has determined that, aside from entirely banning handguns, the Second Amendment to the US Constitution, which declares the right to keep and bear arms, permits many different types of reasonable gun laws including sales restrictions.12

Some previous reviews that included few methodologically strong studies and focused only on US gun control laws, many of which are minimal regulations, concluded that evidence on the efficacy of gun control laws is lacking.1314 These reviews relied on research that is now nearly a decade old and did not include some important outcomes, such as firearm trafficking. Additional research is certainly needed, but this should not stand in the way of prompt decisive action.

Notes

Cite this as:BMJ 2012;345:e8672

Footnotes

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

References

Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2010. www.cdc.gov/ncipc/wisqars.

National Research Council. Firearms and violence: a critical review. Committee to Improve Research and Data on Firearms. Wellford CF, Pepper JV, Petrie CV, eds. Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. National Academies Press, 2005.